In this study, we conducted interviews with staff members who had experience in discharge coordination to clarify the characteristics and efforts of discharge coordination for patients with pediatric cancer toward end-of-life. Focus group interviews were conducted with 11 individuals, including six medical social workers and five nurses (acceptance rate: 84.6%) and a qualitative inductive analysis was conducted. Seven categories were identified as characteristics of discharge coordination for patients with pediatric cancer toward the end-of-life, such as “few home physicians and home health care nurses who could accept terminally ill children” and “a small number of cases and lack of accumulated experience”. Seven categories were identified as efforts of discharge coordination, including “maintaining connections with the community” in three situations: coordination with home physicians and home-visit nursing care, coordination with children and their families, and coordination in hospitals. The number of children who spend their end-of-life days at home is increasing, and we believe that it is necessary to consider expanding the role of pediatric cancer base hospitals in the future, such as collecting information in the community and sharing good practices.

We report a new risk stratification of invasive stage papillary thyroid carcinomas (PTCs) by combining invasive status, using extrathyroid invasion (Ex) status, and tumor growth speed using the Ki-67 labeling index (LI). Methods: We examined tumor recurrence in 167 patients with PTC who were surgically treated at the Kindai University Nara Hospital between 2010 and 2022. The patients were classified according to the degree of invasion [negative (Ex0) or positive (Ex1, Ex2, and Ex3)] and tumor growth speed expressed with Ki-67 LI, as low (<5%) or high (>5%). This study confirmed previous findings that the disease-free survival (DFS) rate in PTCs significantly differed between patients with a high and low Ki-67 index. Results: When combining Ex status (negative or positive) and Ki-67 proliferation status (low or high), the DFS rate of invasion in the negative, low Ki-67 LI group was only 1.1%, while that of invasion in the positive, high Ki-67 LI was 44.1%. This study reports for the first time that recurrence risks can be stratified accurately when combining carcinoma’s essential two features of extrathyroid invasion status and tumor growth speed. Conclusions: We believe the evidence for low tumor recurrence risk may contribute to use of more conservative treatment options for invasive-stage PTCs and help alleviate patient anxiety about tumor recurrence and death.

Objective: We conducted two workshops to encourage “Jinsei Kaigi” to discuss advance care planning (ACP) with family members or significant others during healthy times and evaluated whether the workshops were effectively motivated participants to engage in ACP. Methods: Two workshops were held with 171 welfare commissioners, and four surveys were conducted (T1-T4) before and after the workshops. The primary endpoint was the rate of “Jinsei Kaigi” implementation, and the secondary endpoints were the Japanese versions of the ACP Engagement Survey (ACPES-J), which measures readiness for ACP, and Death Attitude Inventory (DAI), which were compared before and after the intervention, with T1 VS. T4 as the primary analysis. Results: A total of 149 participants were analyzed, and the implementation rate was 38.3%, which was a significant increase from 6% before implementation (p<.001, w=.54). Self-efficacy, readiness, and ACPES-J total scores increased significantly (p<.001 to .031, d=.29 to .67, respectively), but there were no significant changes in DAI. Conclusion: Our results suggest that workshops provide opportunities to motivate engagement in “Jinsei Kaigi”.

We report a new risk stratification of invasive stage papillary thyroid carcinomas (PTCs) by combining invasive status, using extrathyroid invasion (Ex) status, and tumor growth speed using the Ki-67 labeling index (LI). Methods: We examined tumor recurrence in 167 patients with PTC who were surgically treated at the Kindai University Nara Hospital between 2010 and 2022. The patients were classified according to the degree of invasion [negative (Ex0) or positive (Ex1, Ex2, and Ex3)] and tumor growth speed expressed with Ki-67 LI, as low (<5%) or high (>5%). This study confirmed previous findings that the disease-free survival (DFS) rate in PTCs significantly differed between patients with a high and low Ki-67 index. Results: When combining Ex status (negative or positive) and Ki-67 proliferation status (low or high), the DFS rate of invasion in the negative, low Ki-67 LI group was only 1.1%, while that of invasion in the positive, high Ki-67 LI was 44.1%. This study reports for the first time that recurrence risks can be stratified accurately when combining carcinoma’s essential two features of extrathyroid invasion status and tumor growth speed. Conclusions: We believe the evidence for low tumor recurrence risk may contribute to use of more conservative treatment options for invasive-stage PTCs and help alleviate patient anxiety about tumor recurrence and death.

We report a new risk stratification of invasive stage papillary thyroid carcinomas (PTCs) by combining invasive status, using extrathyroid invasion (Ex) status, and tumor growth speed using the Ki-67 labeling index (LI). Methods: We examined tumor recurrence in 167 patients with PTC who were surgically treated at the Kindai University Nara Hospital between 2010 and 2022. The patients were classified according to the degree of invasion [negative (Ex0) or positive (Ex1, Ex2, and Ex3)] and tumor growth speed expressed with Ki-67 LI, as low (<5%) or high (>5%). This study confirmed previous findings that the disease-free survival (DFS) rate in PTCs significantly differed between patients with a high and low Ki-67 index. Results: When combining Ex status (negative or positive) and Ki-67 proliferation status (low or high), the DFS rate of invasion in the negative, low Ki-67 LI group was only 1.1%, while that of invasion in the positive, high Ki-67 LI was 44.1%. This study reports for the first time that recurrence risks can be stratified accurately when combining carcinoma’s essential two features of extrathyroid invasion status and tumor growth speed. Conclusions: We believe the evidence for low tumor recurrence risk may contribute to use of more conservative treatment options for invasive-stage PTCs and help alleviate patient anxiety about tumor recurrence and death.

[Objectives] The increase in skin temperature due to acupuncture treatment has been reported visually using thermography and other techniques. In this study, we measured the main acupuncture temperatures of the whole body before and after treatment, captured the characteristics of the correlation between pre- and post-treatment temperatures, and discussed the mechanism of cooling improvement. [Methods] Eight women who were aware of their coldness, who gave informed consent, were treated during a particularly cold season (December X to X+1 February). As a whole body treatment, five minutes of acupuncture was applied to CV12, ST25, and CV4 in the abdomen, BL10 and GB20 in the cervical region, BL17, BL18, BL20, and BL23 in the back, and BL40 and BL58 in the feet. Before and after treatment, the temperatures of the acupuncture points of the whole body (CV22, CV14, CV8, CV4, GB26, PC6, TE5, BL15, SP6, KI1, GV12, GV9, and GV4) were measured with a non-contact thermometer. Subsequently, for each acupuncture point, a graph plotting the temperature before and after treatment was created, and temperature changes before and after treatment were assessed by t-testing, and the presence or absence of attribute trends in pre-treatment acupuncture point temperature was assessed by linear regression analysis.[Results] For the abdomen, medial upper extremity, and medial lower extremity, transapical temperature increased significantly after treatment, uniformly independent of pre-treatment temperature. For the dorsal, lateral upper extremity, and lateral lower extremity, the acupuncture temperature did not rise uniformly after treatment; the lower pre-treatment temperature increased after treatment, but the higher pre-treatment temperature decreased after treatment. The temperature of the lateral abdomen and the soles of the feet increased significantly after treatment, and the degree of increase was greater in people with lower pre-treatment temperatures. And this balance of heat was found to promote blood flow to the tip of the foot.[Discussion] After the whole-body treatment as in this study, it is thought that by confirming the temperature measured before and after the treatment, in addition to the subject's subjective awareness of the warmth of his or her body, it is possible to convince the subject of the meaning of the treatment and to improve his or her main complaint. I thought it could be introduced as a method of examination.

Objective: To introduce a successful experience of tapering high-dose opioids using spinal analgesia. Case: A 53-year-old man suffering from buttock-pain due to sacral metastasis of rectal cancer, was referred to our hospital for specialized cancer pain treatment and opioid reduction. At the time of admission, he was taking 5040 mg/day of oral morphine equivalent dose of opioids and NRS was still 10/10. Although the dosage was too high, an illicit transactions, diversion or psychological dependence were ruled out. Exacerbation of pain and tolerance formation due to the rapid increase of opioid dose seemed to be a vital factor. After admission, the high-dose opioid was gradually reduced while epidural and intrathecal analgesia were introduced. After 30 days of adjustment, the dose of systemic opioid was finally reduced to 120 mg/day (oral morphine equivalent) with 24 mg/day of intrathecal morphine at the time of transfer to his primary hospital. Conclusion: Cancer pain can result in high-dose opioids administration. Specialized pain treatment may be useful in weaning patients from high-dose opioids, but early concomitant use is recommended to avoid becoming high-dose opioid.